Journal of Healthcare Management最新文献

{"title":"Aligning Federal Grant Review Processes with Academic Standards: A Call for Reform.","authors":"","doi":"10.1097/JHM-D-25-00013","DOIUrl":"https://doi.org/10.1097/JHM-D-25-00013","url":null,"abstract":"","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"70 2","pages":"75-81"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leveraging Artificial Intelligence to Reduce Neuroscience ICU Length of Stay.","authors":"Kiran Kittur, Keith Dombrowski, Kevin Salomon, Jennifer Glover, Laura Roy, Tracey Lund, Clint Chiodo, Karen Fugate, Anish Patel","doi":"10.1097/JHM-D-23-00252","DOIUrl":"10.1097/JHM-D-23-00252","url":null,"abstract":"<p><strong>Goal: </strong>Efficient patient flow is critical at Tampa General Hospital (TGH), a large academic tertiary care center and safety net hospital with more than 50,000 discharges and 30,000 surgical procedures per year. TGH collaborated with GE HealthCare Command Center to build a command center (called CareComm) with real-time artificial intelligence (AI) applications, known as tiles, to dynamically streamline patient care operations and throughput. To facilitate patient flow for our neuroscience service line, we partnered with the GE HealthCare Command Center team to configure a Downgrade Readiness Tile (DRT) to expedite patient transfers out of the neuroscience intensive care unit (NSICU) and reduce their length of stay (LOS).</p><p><strong>Methods: </strong>As part of an integrated NSICU performance improvement project, our LOS reduction workgroup identified the admission/discharge and transfer process as key metrics. Based on a 90%-plus average capacity, early identification of patients eligible for a downgrade to lower acuity units is critical to maintain flow from the operating rooms and emergency department. Our group identified clinical factors consistent with downgrade readiness as well as barriers preventing transition to the next phase of care. Configuration of an AI-powered model was identified as a mechanism to drive earlier downgrade and reduce LOS in the NSICU. A multidisciplinary ICU LOS reduction steering committee met to determine the criteria, design, and implementation of the AI-powered DRT. As opposed to identifying traditional clinical factors associated with stability for transfer, our working group asked, \"What are clinical barriers preventing downgrade?\" We identified more than 76 clinical elements from the electronic medical records that are programmed and displayed in real-time with a desired accuracy of over 95%. If no criteria are present, and no bed is requested or assigned, the DRT will report potential readiness for transfer. If three or more criteria are present, the DRT will suggest that the patient is not eligible for transfer.</p><p><strong>Principal findings: </strong>The DRT was implemented in January 2022 and is used during multidisciplinary rounds (MDRs) and displayed on monitors positioned throughout the NSICU. During MDRs, the bedside nurses present each patient's key information in a standardized manner, after which the DRT is used to recommend or oppose patient transfer. Six months postimplementation period of the DRT and MDRs, the NSICU has seen a 7% or roughly eight-hour reduction in the ICU length of stay (4.15-3.88 days) with a more than three-hour earlier placement of a transfer order. Unplanned returns to the ICU (or bouncebacks) have remained low with no change in the preimplementation rate of 3% within 24 hours. As a result of this success, DRTs are being implemented in the medical ICUs.</p><p><strong>Practical applications: </strong>This work is uniquely innovative as it shows AI can","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"70 2","pages":"126-136"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Twelve Considerations for the Future of Healthcare.","authors":"Robert W Allen","doi":"10.1097/JHM-D-25-00012","DOIUrl":"https://doi.org/10.1097/JHM-D-25-00012","url":null,"abstract":"","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"70 2","pages":"87-92"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated with Healthcare Leaders' Perceived Self-Efficacy During Crises.","authors":"Robin Moreno","doi":"10.1097/JHM-D-24-00067","DOIUrl":"10.1097/JHM-D-24-00067","url":null,"abstract":"<p><strong>Goal: </strong>The COVID-19 pandemic exposed a lack of healthcare leadership preparedness for a widespread, persistent emergency. This study aimed to identify factors contributing to perceived leadership self-efficacy to better prepare leaders for future crises.</p><p><strong>Methods: </strong>The researcher conducted an online composite survey (n = 96) of factors affecting perceived leadership self-efficacy from an American College of Healthcare Executives group using a quantitative correlational design with multiple regression analysis. Results were examined through the lens of Kolb's experiential learning theory to determine recommended leadership training.</p><p><strong>Principal findings: </strong>The researcher found that the most significant factors contributing to perceived self-efficacy in leadership were years of experience and skill (β = .004). This was supported by a multiple regression model predicting leadership self-efficacy, F(6, 95) = 9.932, p < .001, and adjusted ΔR2 = .361. An overall moderate effect size supports the practical significance of these results. When given the opportunity to indicate what preparation would be most beneficial, healthcare leaders indicated a desire for more training in communication skills alongside tabletop drills to practice rapid assessment and response techniques.</p><p><strong>Practical applications: </strong>As healthcare leaders continue to face unanticipated challenges, their self-perceived ability to handle crises competently is influenced by their years of experience and skill level. Of these two, skill level is practically addressable. Education and leadership development that incorporate evolving methods of training, such as tabletop drills, will improve critical skills, and thus, perceived self-efficacy during times of crisis.</p>","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"70 2","pages":"137-148"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation of Mindfulness Practices, Resilience, and Compassion Satisfaction in Hospital-Based Healthcare Workers: A Randomized Controlled Trial.","authors":"Heather Liska, Megan Bentzoni, Courtney Donovan, Ben Gaibel, Alison Hueth, Adrienne Johnson, Mary Shepler, Deb Roybal, Meredith Mealer","doi":"10.1097/JHM-D-23-00123","DOIUrl":"https://doi.org/10.1097/JHM-D-23-00123","url":null,"abstract":"<p><strong>Goal: </strong>A lack of healthcare worker well-being is a serious threat to patient care quality and safety, as well as to the overall operational performance of hospitals in the US healthcare delivery system. Extreme resilience depletion and compassion fatigue are known to negatively influence individual well-being and have contributed to the rise in turnover in the healthcare workforce. The primary aim of this research was to identify interventions that health system leaders can use to combat resilience depletion and exhaustion among healthcare workers.</p><p><strong>Methods: </strong>Researchers deployed a randomized controlled trial methodology to study the association between the use of regular mindfulness practices, resilience, and compassion satisfaction. After completing an initial screening questionnaire and preassessments, participants were randomized into one of two groups: (1) an experimental group with mindfulness practices as the intervention and (2) a control group. The experimental group participated in structured mindfulness practices during their regular workday on three different days per week for a minimum of 10 minutes per day. At the end of the six-week study period, both groups completed postassessment questionnaires. Results from the pre- and postassessments were analyzed to determine the correlation between mindfulness practices, resilience, and compassion satisfaction.</p><p><strong>Principal findings: </strong>Data analysis revealed that baseline resilience scores in the experimental group increased by 4 points, with a progressive 92% power. In addition, the experimental group demonstrated a statistically significant improvement in resilience (p mean difference pre-post = .147/.002) and compassion satisfaction (p mean difference pre-post = 3.99/.019).</p><p><strong>Practical applications: </strong>Readily available, low-cost mindfulness practices may be introduced to hospital staff to build resilience and improve compassion satisfaction. In turn, this may help support hospital efforts to reduce turnover in the healthcare workforce.</p>","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"70 1","pages":"16-31"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advance Care Planning Billing Codes Associated With Decreased Healthcare Utilization in Neurological Disease.","authors":"Gregory Brown, Sol De Jesus, Emily Leboffe, Andy Esch, Kristina Newport","doi":"10.1097/JHM-D-23-00234","DOIUrl":"https://doi.org/10.1097/JHM-D-23-00234","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Goals: &lt;/strong&gt;Advance care planning (ACP) procedure codes have been established to reimburse meaningful care goal discussions; however, the utilization frequency of these codes in neurological disease is unknown. The objective of this study is to identify the association between ACP codes and healthcare utilization in chronic neurodegenerative diseases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a multicenter cohort study using real-world electronic health data. Using the TriNetX database, we collected electronic health data from 92 institutions in the United States. We included patients aged 65 and older who had been diagnosed with one of four neurological diseases: Alzheimer's disease, Parkinson's disease, multiple sclerosis, or amyotrophic lateral sclerosis (ALS). Patients with congestive heart failure were included as a reference. From the 64,683,009 total patients in the database, 877,138 had Alzheimer's disease, 544,610 had Parkinson's disease, 208,341 had multiple sclerosis, 9,944 had amyotrophic lateral sclerosis, and 1,500,186 had congestive heart failure. For each disease, we compared hospitalizations and emergency department (ED) visits over a two-year period between patients with and without ACP codes documented. Then, in patients with ACP, we investigated the rates of hospitalizations and ED visits over the two years before ACP and two years after ACP to understand the impact of ACP on the healthcare utilization trend. All patients had records for at least two years after index.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Principal findings: &lt;/strong&gt;The rate of ACP code documentation ranged from 1.8% of multiple sclerosis patients to 3.6% of Alzheimer's disease patients. After matching for demographic and health variables, usage of ACP codes was associated with significantly fewer hospitalizations for Alzheimer's disease patients. Across all diseases, there was a 20% to 30% decrease in ED visits, which was significant. Furthermore, there was a significant change in the trend of hospitalizations and ED visits for patients after ACP documentation. Patients went from increasing utilization before ACP documentation to decreasing utilization after documentation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Practical applications: &lt;/strong&gt;ACP billing codes are used infrequently in neurological disease, which may indicate that reimbursement alone is not sufficient to drive code usage. Usage of ACP billing codes was associated with decreased healthcare utilization, particularly in terms of ED visits. Beyond the primary objective of providing goal-concordant care, ACP may impact the economic burden of chronic neurodegenerative disease, which has high costs of care in our aging society. There may be particular benefits with Alzheimer's disease, which had an impact on both hospitalizations and ED visits and is the most prevalent neurodegenerative disease. Future work is needed to better understand the best implementation strategy for ACP in a multifaceted approach that emphasizes patient care","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"70 1","pages":"58-73"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moral Distress Consultation Services: Insights From Unit- and Organizational-Level Leaders.","authors":"Vanessa Amos, Phyllis Whitehead, Beth Epstein","doi":"10.1097/JHM-D-24-00028","DOIUrl":"https://doi.org/10.1097/JHM-D-24-00028","url":null,"abstract":"<p><strong>Goal: </strong>The objective of this study was to better understand how healthcare systems' unit- and system-level leaders perceive and experience moral distress consultation services, including their utility, efficacy, and sustainability.</p><p><strong>Methods: </strong>A multimethod design was conducted in tandem across two academic medical centers with longstanding and active moral distress consultation services. Moral distress data for healthcare providers participating in moral distress consultation were collected. The authors also conducted interviews about moral distress consultation with unit and organizational leaders using a semistructured interview format. They analyzed interview transcripts using both inductive and deductive coding strategies. Relevant themes and categories were then transferred onto a thematic map for final analysis.</p><p><strong>Principal findings: </strong>Twenty moral distress consults (10 at each institution) were held during the five-month study period. The mean reported moral distress score for all preconsult participants (n = 52) was 6.9 (SD = 2.5), with scores ranging from 0 to 10. In the combined presurvey and postsurvey group (n = 22), the mean moral distress score was 5.9 (SD = 2.2) prior to the consult and 5.3 (SD = 2.7) after the consult. Participants indicated that moral distress causes were primarily team-level-focused prior to moral distress consultation and system-level-focused after consultation. As consult data were collected, eight unit- and system-level leaders were interviewed. Leaders described moral distress consultation as valuable and empowering to unit-based staff. They endorsed the service's ability to create safe spaces for open communication about morally distressing events. Leaders also suggested the need for more diverse professional representation (outside of nursing) among consultants and participants, as well as more transparent and consistent education plans related to the service, not only to increase leaders' knowledge and awareness of moral distress, but also to increase the visibility of the consult service, both within and outside the organization. Finally, leadership teams valued qualitative accounts of morally distressing events from staff.</p><p><strong>Practical applications: </strong>Addressing moral distress requires intentional and systemic collaboration, including open communication between moral distress consultation leaders, participants, and unit- and system-level leadership teams. Transparent education plans, broad professional representation, and flexible success measures-including both quantitative and qualitative metrics-are necessary and should be considered for any current or developing moral distress consultation services.</p>","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"70 1","pages":"32-48"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a New Paradigm for Healthcare Delivery: Lessons Learned from Same-Day Access.","authors":"Allen M Chen","doi":"10.1097/JHM-D-23-00258","DOIUrl":"https://doi.org/10.1097/JHM-D-23-00258","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Goal: &lt;/strong&gt;Excessively lengthy wait times for appointments with clinicians are a major source of frustration for patients, and difficulties with access represent a public health problem facing populations across all societies. As delays in care have been associated with inferior outcomes, same-day appointments have been proposed as a patient-centric means of improving healthcare delivery. However, this paradigm represents a radical shift from conventional scheduling tactics, and skepticism has long existed regarding its feasibility and real-world applicability to clinical practice. Given the limited data available about same-day access and the lack of guidance on this strategy, the need to evaluate experiences and engage in introspective reflection (i.e., examine thoughts, emotions, judgments, and perceptions) for quality improvement are paramount. Thus, the purpose of this study was to review a single-institutional practice with same-day access, focusing on lessons learned over a two-year period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;From March 2021 to March 2023, a total of 4,301 consecutive patients with newly diagnosed cancer were offered same-day appointments as part of a prospective pilot initiative conducted in the outpatient setting at a tertiary-based academic medical center. Systematic analysis demonstrated the positive impact of this initiative on access-related benchmarks. A retrospective review was conducted to identify core themes pertaining to the feasibility of the initiative with respect to its design and implementation. An interpretive synthesis was then presented in descriptive fashion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Principal findings: &lt;/strong&gt;Of the 3,414 patients scheduled, 477 (14%) opted for same-day appointments. While same-day appointments significantly reduced the time to consultation and treatment for patients with newly diagnosed cancer, the initiative presented new challenges-both expected and unexpected-that could have hindered its development, acceptance, and adoption. These challenges related to scheduling capacity, logistical coordination, workflow efficiency, resource allocation, and cultural change. A consistent, proactive management approach, coupled with an unwavering commitment to communication, was required to overcome these operational barriers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Practical applications: &lt;/strong&gt;Same-day appointments in the ambulatory setting has the potential to improve health outcomes and care quality, while fundamentally changing the way healthcare is delivered for the betterment of patients. However, thoughtful preparation and team-based planning are imperative to establish a methodical approach that will optimize the likelihood of success. Given the potentially disruptive nature of this paradigm, the need for steady leadership, accompanied by the consistent promotion of standardized guidelines, is critical to ensure engagement among all stakeholders. Lastly, the importance of promoting positive cultural change a","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"70 1","pages":"49-57"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Healthcare Systems in Workforce Housing: An Urban and Rural Imperative.","authors":"","doi":"10.1097/JHM-D-24-00268","DOIUrl":"https://doi.org/10.1097/JHM-D-24-00268","url":null,"abstract":"","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"70 1","pages":"1-6"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Michael A. Slubowski, FACHE, President and CEO, Trinity Health.","authors":"","doi":"10.1097/JHM-D-24-00267","DOIUrl":"https://doi.org/10.1097/JHM-D-24-00267","url":null,"abstract":"","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"70 1","pages":"7-11"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}